Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, UTHSCSA

Nonviable tissue in the wound bed can be divided into 2 broad categories: slough and eschar. Although these terms are sometimes used interchangeably, it is vital to distinguish between them as they may require different management methods. Dry, hard, leathery tissue in the wound bed is referred to as Eschar. Eschar is a type of necrotic tissue that is secondary to cell death following tissue injury (ie, pressure, trauma, impaired perfusion). Slough, in comparison, is usually seen as well hydrated, soft yellow or white tissue. This tissue may be loose and stringy or adherent and is the byproduct of the inflammatory phase of wound healing.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

A 55-year-old African American male was admitted to our inpatient rehabilitation facility (IRF) with a right trochanter stage 4 pressure injury, sacral stage 3, and left below the knee amputation (L BKA) with comorbid diabetes mellitus (DM) and end-stage renal disease (ESRD). A 2-person skin assessment was completed on admission by 2 RNs, one of whom had worked in a wound clinic for several years. While changing his negative pressure wound therapy device on his right hip 1 week later, I decided to check his right heel. He had evidence of callus and ashy skin, but I thought I could see an injury curved around the callus area, as seen in image 1. Upon further inspection, I discovered a stage 2 blister approximately 4x5 cm. The skin had the texture of dry, crumpling, thin cardboard. He had no sense of pain in the area. As an amputee, he did not have another heel to compare temperature, texture, or color.

Christine Miller, DPM, PhD

As the holiday season approaches, bundles of mistletoe will no doubt appear in many homes across the world. This popular holiday decoration, with its green leaves and white berries dangling from doorways, may induce the act of kissing between passersby. Mistletoe (Viscum album L.) is a semi-parasitic shrub that often grows upon oak, pine, and elm trees and is a member of the Viscaceae family commonly found in northern Europe. One may never look at mistletoe the same after learning about its therapeutic offerings, especially as those therapeutic properties relate to wound care.

Elizabeth Day Dechant, BSN, RN, CWOCN, CFCN

The benefit of Negative Pressure Wound Therapy (NPWT) as an “active,” adjunctive treatment is well-established. Evidence has shown that wounds treated with negative pressure granulate faster than wounds managed with traditional dressings. There is ever-increasing literature to support the use of NPWT to treat wounds effectively and safely in even the youngest patients.¹ Some specific benefits of NPWT for pediatric and adolescent patients include decreased frequency of dressing changes, as well as a dressing that is occlusive and unlikely to be removed by the patient.